Doctors hold the well-being and interests of their patients in
their hands. The matter of their continuing fitness to practise is
therefore an important one. The manner in which the Singapore
Medical Council (SMC) Ethical Code and Ethical Guidelines (ECEG)
addresses this issue is to focus on the best interests of the
doctors concerned as well as that of their patients.

Article 4.7.1 of the ECEG states that doctors who become aware
that they are suffering from a condition that renders them unfit to
practise should seek appropriate medical treatment. Essentially
doctors are being reminded that there is a need to take care of
their own health and well-being. It is possible that with proper
treatment the doctor’s condition may improve and allow him to
resume his practice. Article 4.7.2 then goes on to state that the
doctor also has an ethical duty to disclose the nature of his
medical condition to the SMC, either because the medical condition
is a serious one that can be transmitted to a patient, or his
condition would significantly impair his professional competence as
a doctor. This underscores the importance of ensuring that the
doctor’s medical condition is brought to the attention of the
regulator, so that there can be independent and objective
consideration of whether it would be in the interests of the
doctor’s patients that he be allowed to continue to practise. Since
the doctor can only be expected to report his condition to the SMC
if in the first place he is able to appreciate and understand his
illness and its ramifications, Article 4.7.2 goes on to clarify
that this is a duty that is imposed on a doctor “if he is of sound
mind”.

In the present case, Dr. G appears to lack insight into his own
condition. He probably does not see that there is anything to
report to the SMC, because he does not even realise and accept that
he is ill. He has flatly denied that he has a psychotic disorder.
He has refused medication and does not appear to acknowledge that
he even requires any treatment. He certainly appears to lack
comprehension of how his professional competence as a practising
family physician may be compromised in any way. This being the
case, the ethical duty to report his condition to the SMC, with
likely repercussions on his continuing right to practise, is not so
much thrust upon Dr. G himself but upon the doctors who are
treating him and who may have diagnosed him with a condition that
renders him unfit to practice.

Article 4.7.3 of the ECEG states:

Doctors must protect patients from risk of potential harm posed
by another doctor’s conduct, performance or health. Where a doctor
has grounds to believe that another doctor may be putting patients
at risk, he must inform the SMC.

A doctor who treats another doctor for a condition that renders
him unfit to practise has a special responsibility to alert the
SMC.

It seems clear that Dr. G is currently unfit to practise, unless
and until such time as he is successfully treated for his
condition. This is the reasonable conclusion that one reaches, not
simply because Dr. G has admitted to hearing voices and receiving
instructions from God and hearing the voice of the Devil, and not
even because he appears convinced that he has the gift of healing
by the laying of hands. Based on this alone, some may argue that
Dr. G is simply a very religious man with certain beliefs, and we
should be slow to declare a doctor unfit simply because he has
eccentric ideas. However, in Dr. G’s case, the voices he has been
hearing and his conviction in his ability to heal patients by
laying hands and without resorting to the use of conventional
medical treatment such as medication, has clearly significantly
altered his view of what treatments he would prescribe or
administer to his patients. If he believes that conventional
medical therapies are from the Devil, he will obviously withhold
such treatments from his patients, even though they may be proven
and medically appropriate medical...

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